Dr Arun

NEWS

August 15, 2016 News

What can be done about Pelvic Organ Prolapse ?

Although no one talks about it, pelvic organ prolapse is fairly a common problem in women. The term refers to one or more pelvic organs dropping from their usual positions.

Pelvic Organ Prolapse

Prolapse is a condition where there is a sensation of a mass bulging from your vagina, or a feeling of heaviness in your pelvic area. And even though millions of women are affected, studies show that women are reluctant to discuss it, even with a doctor. As a result, a silence persists that leaves women unaware they do not have to live with this.
Prolapse can be caused by muscles and ligaments that have been weakened or damaged. The most common causes include pregnancy, childbirth, menopause, obesity, aging or previous surgery.

Ask yourself the following questions:

Have you felt a bulge or lump in your vagina, or feel like something is falling out?
Do you experience pain or discomfort during intercourse?
Do you experience vaginal pain, pressure, irritation, bleeding or spotting?
Do you experience problems with urination, or difficulty with bowel movements?
Do you have frequent lower back pain?

Answering YES to any of these questions could be an indication that you may be experiencing some form of prolapse. What a relief to know that this condition is treatable – you don’t have to live with it – and there are now a number of minimally invasive, treatment options available.

What is the pelvic floor?

The pelvic floor is the hammock of muscles which spans the pelvis from front to back and is responsible for supporting all the pelvic organs and controlling the openings.

How does it work and what causes it to weaken?

The muscles are usually firm and slightly tense to prevent leakage from the bladder and bowel and to maintain the normal position of the organs and thus prevent a prolapse.
When you empty your bladder or bowels the muscles relax and then tighten again to restore control. The muscles can get weaker gradually, possibly over several years.
Childbirth, chronic constipation, being overweight are all factors which can weaken muscles and once this happens they cannot perform their functions of support and control as efficiently as before and this is when the problems usually become obvious.
Other factors affecting the pelvic floor muscles include aging, the menopause and reduction of oestrogen, being a smoker or having a chronic cough. An occupation that involves repeated lifting can also lead to a greater risk of pelvic floor dysfunction.

What is prolapse?

When the pelvic floor weakens, it causes the supports of the various parts of the vagina and sometimes the uterus to loosen. This results in these structures ‘dropping’ so that they can be felt outside the body, or cause problems with passing urine or stools without being replaced. This is commonly called prolapse.
Sometimes, the vaginal opening can be larger especially when a lady has had many vaginal deliveries.

Types of Prolapse

Normal Female Pelvic Anatomy
Normal Female Pelvic Anatomy

Cystocele (dropping of the bladder into the vagina) occurs when the wall between the bladder and the vagina weakens, causing the bladder to drop or sag into the vagina.

Screen Shot 2016-08-15 at 11.27.15 AM

Rectocele (pushing of the rectum into the vaginal wall) occurs when there is a bulge in the lower back vaginal wall caused by the front wall of the rectum sagging and pushing against it.

Screen Shot 2016-08-15 at 11.28.17 AM

Vault prolapse (sagging of the top of vagina after hysterectomy) occurs when there is a weakness to the support of the top of the vagina.

Screen Shot 2016-08-15 at 11.29.31 AM

Uterine prolapse (Bulging of the uterus into the vagina) occurs by itself or can be accompanied with cystocele, rectocele or enterocele.

Enterocele (Bulging of the small intestine into the vaginal wall) occurs when the small intestine bulges into the upper back vaginal wall.

How is a prolapse diagnosed?

Prolapse is diagnosed by a trained consultant or nurse when doing a pelvic examination.

What problems can it cause?

Feeling of something coming out of the vagina
Difficulty with passing urine or stools
Soreness and vaginal discharge with or without an infection
Backache and pelvic pain
Kidney pains in severe conditions with repeated urinary and kidney infections
Urinary leakage and recurrent cystitis
Difficulty with sexual intercourse

When do I need to see a doctor about prolapse?

If the prolapse is getting worse, or if there is any difficulty with passing urine or stools, you need to seek treatment as soon as possible
If you get repeated urinary tract infections and you know you have a prolapse you should seek treatment
If you feel your relationship with your partner is suffering as a result of your prolapse or urinary incontinence

Conservative treatment

Physiotherapy – pelvic floor exercises can be very useful in those women with mild degrees of prolapse and/or stress incontinence. Perseverance and professional help with these exercises is important.

Surgery

If conservative measures fail to improve the situation, the options of surgery may be discussed with a gynaecologist. The following operations are available:
Treating Uterine Prolapse – there are two surgical approaches to treating a uterine prolapse: removing the uterus altogether (hysterectomy) or lifting it and holding it in place (suspension).
Suspending the Uterus – treatments that suspend rather than remove the uterus are recommended for women who want to keep their uterus or have children in the future. Procedures can be done either vaginally or abdominally, and there is some evidence to suggest that abdominal repairs tend to have better long-term results. The options are between sacrocolpopexy (using special mesh) and sacrospinous fixation. Key hole surgery (laparoscopy) is usually used.

Anterior Repair (colporrhaphy) – tightens up the front walls of the vagina – this procedure is used to treat prolapse of the bladder (cystocele), urethra (urethrocele) or both the bladder and urethra (cystourethrocele).

Posterior repair or posterior colporrhaphy – tightens up the back wall of the vagina – posterior repair is used to treat prolapse of the rectum (rectocele) and small bowel (enterocele). Mesh may be used.

Seeking help

Many women delay seeking help for this condition due to embarrassment.

For Treatment enquiries, please contact

Dr. A S Arun MD DNB CCST, FRCOG, FRANZCOG

Waikiki Specialist Centre
221 Wilmott Drive
Waikiki 6169
WA

Tel: 08 95500300
Fax: 08 95929830
Email: specialists@waikikiprivatehospital.com

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